Organization
REVIVE WELLNESS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL DYER MD (PRESIDENT)
(423) 552-1531
Entity
Organization
Contact information
Practice address
850 W MAIN ST, ROGERSVILLE, TN 37857-3663
(423) 500-0266
Mailing address
850 W MAIN ST, ROGERSVILLE, TN 37857-3663
(423) 500-0266
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44247
MEDICAL LICENSE
TN
Enumeration date
02/17/2020
Last updated
02/17/2020
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